Medical Services Information Disclosure And Regulation For Public Hospitals In China

To enhance medical services information disclosure and regulation is one of the basic principles of and requirements to the modern medical regulation system. Medical services information disclosure for public hospitals is conducive to the health seeking behavior of people, can reduce the supplier induced demand caused by the healthcare market information asymmetry, and decrease the "knowledge gap" between supplier and demander of medical services. It also can promote the public hospitals to normalize medical practice, improve quality, and reduce the price of services, so that the public hospitals provide the optimal healthcare services for the public.Research ObjectivesThe current domestic practice and researches of medical services disclosure and regulation were limited. The current study focused on the medical services information disclosure for public hospitals. The research objectives were:to review the theories and practice on hospital medical services information disclosure at domestic and overseas, to comprehensively analyze macro policy environment, the roles of interest groups such as the governments, hospitals on Chinese public hospital medical services information disclosure, to investigate the current situation of information disclosure, to summarize experiences and to explore the problems and influencing factors on hospital medical services information disclosure, and to put up suggestions on hospital medical services information disclosure regulation and operational mechanism. Data Sources and MethodsThis study adopted both the theoretical and empirical, both qualitative and quantitative research methods. Medical services information disclosure and regulation for public hospital was analyzed theoretically from the perspectives of Right to Know Theory, Asymmetric Information Theory, Information Communication Theory and Government Regulation Theory. Macro policy environment of information disclosure, the roles and the relationships among and behavioral characteristics of stakeholders were analyzed using PEST Analysis, Stakeholder Analysis, and Game Theory Analysis, respectively.The empirical investigation was carried out at both government level and hospital level. At government level, portal websites of 31 provincial health administrative departments were investigated to understand the institution construction, operating mechanism, the content of the information disclosure, and etc.At hospital level, according to the level of economic development,35 public hospitals in 12 cities of 6 provinces were sampled in the eastern, central and western regions. Portal websites of the hospitals were investigated,1371 patients and their family members and 1868 health care professionals conducted the questionnaire surveys. Semi-structured in-depth interviews were conducted with forty key informants from health administrative departments, hospitals, professional associations, health insurance sectors, the media and etc. health administrative departmentsEpiData3.1 and SPSS 12.0 were used to manage data and for statistical analysis. Descriptive analysis, chi-square test, correspondence analysis, cluster analysis, and Logistic regression analysis were conducted. Typical case study was also used.Key Findings1.Theoretical Analysis on medical services information disclosure and regulation for public hospitalsThe concepts of medical services information, medical services information disclosure, and regulation were defined based on the information disclosure research conclusions in other fields. Through reviewing history of medical services information disclosure from 1949, the four stages were identified and the characteristics in each stage were described.PEST analysis presented that Macro policy environment of medical services information disclosure and regulation:disclosure and regulation of medical services for public hospitals was an inevitable trend the medical and health undertakings development; increase of health care costs and the tense physician-patient relationship made it necessary to disclose and regulate medical services information; and the rapid popularization of the Internet, the substantial increase of Internet users and the development of information construction in hospitals laid the foundation of medical services disclosure and regulations.Stakeholder Analysis pointed out the benefits, the resources, capability to apply resources, and standpoint of stakeholders the governments, hospitals, public and third-party organizations.Game Theory Analysis was used to analyze the multiple game relationships among stakeholders (health administrative departments, public hospitals and the patients) and to propose the conditions in which the efficiency of medical services disclosure and regulations could be increased.2. Empirical research findings of medical services information disclosure and regulation for public hospitals:governments'behavior and hospitals'behaviorThe investigation of the institution building, disclosure content and channels of government information disclosure practice indicated that 30 provincial health administrative departments had established portal websites (except Tibet health administrative department) and 28 departments published their institution framework of information disclosure on the websites.Information disclosure models and mechanisms of the local governments were different and institution building and support system should be strengthened. The disclosure content were mainly concerned with treatment expenses, prices of pharmaceutical and medical service, numbers of outpatient and emergency, service efficiency, expenses per outpatient/discharged patient, the health professionals and their on-duty time, and etc. Some departments disclosed the information of medical service quality (41.18%), and were concerned with the evaluation of demander (5.88%). The Internet was the main channel for information disclosure the governments. As for the active disclosure and disclosure upon application, the governments disclosed actively much information;however the channel of disclosure upon application did not work well, which should be paid more attention.At public hospitals level, the hospitals attached importance to the information disclosure, which could be seen in the evidence that among 31 hospitals,26 ones established Opening Hospital Affairs Leadership Team and 27 ones formulated relevant institutions. However, the Internet as an important channel disclosure and self-advertising had not been given sufficient attention by the managers. The availability of the information consultation phone should be increased. And the hospitals should be more concerned with the medical service evaluation of the demander.3.Stakeholders evaluation of medical services information disclosure for public hospitalsThe evaluation of the public, health professionals, and other stakeholders such as the media, health insurance sectors and professional associations on medical services information disclosure were analyzed. As for the public (represented by the inpatients), 76.8% of people seldom searched medical services information of hospitals, which indicated their active consciousness and participation was not enough.21.5% of people obtained the available information in the past experiences health care information query, which indicated that benefits of the information disclosure by the governments were not enough.Some indicators were medical terminology;therefore, it was difficult to understand for the public.31.30% of the public were satisfied with hospitals information disclosed by the governments. Correspondence analysis revealed that public satisfaction was significant related to the educational level (x2=24.802, P<0.001), health status (χ2=44.103, P<0.001). The supervision of the public was limited and there was a corresponding relationship between the extent of out-patients supervision and visiting times (χ2=17.486, P<0.01). The awareness level about medical services information disclosed by hospitals in inpatients was high.54.12% of inpatients were satisfied with information disclosure and the satisfaction of male was lower than female (χ2=7.415,P<0.01, OR=0.73) and patients with poor health status lower than patients with good health status(χ2=22.483,P<0.001,OR=0.36).37.17% of the health professionals were satisfied with medical services information disclosure by the governments.70.28% of them reported they had little or no supervision to governments information disclosure. There was a corresponding relationship between the supervision and length of working (χ2=13.008, P<0.05)..Only 14.64% hospital staff were always concerned with internal information disclosure within hospitals, which showed the concern of hospital staff should be improved.Although professional associations were an important stakeholder in medical services information disclosure and regulation, they played an unimportant role in practice because of the underdeveloped status of professional self-regulatory organizations.Health insurance sectors had limited access to information, insufficient regulatory, and were inefficient to obtain comprehensive and objective information on medical services. As one kind of channels of governments information disclosure, the media's concerns and effects should be improved.4. The barriers of medical services information disclosure for public hospitalsBased on typical case analysis with three health administrative departments and two hospitals, key informant interviews, and other qualitative data analysis, the barriers of information disclosure were analyzed. At government level, the regulation model was single, the disclosure subject was unclear, disclosure consciousness was low, disclosure content was single, informatization construction was incomplete, supporting system should be strengthened, and etc. At hospitals level, the hospitals" cognition about the purpose and significance of the medical services information disclosure should be improved, the information construction level varied from hospital to hospital, the special funds and full-time staff lacked, information disclosure annual reporting and accountability system lacked, supporting system should be strengthened. Conclusions and SuggestionsBased on theoretical analysis and empirical findings, the suggestions on health services information disclosure and regulation for public hospitals in China were proposed, and the disclosure system should be in line with our national conditions, and feasible.1.To determine the regulation philosophy, goals and principles of medical services information disclosure and regulation for public hospitalsThe governments at all levels, the hospitals, the public, other stakeholders should play respective roles in information disclosure and regulation. The goals at macro-, medium-, and micro- levels were proposed. The principles included meeting the needs, appropriateness, cost-effective, discriminatory design, and gradual implementation.2. To establish the medical services information disclosure and regulation system construction framework for public hospitalsFirstly, to strengthen information disclosure models and mechanisms and to develop the new market subject. Secondly, to construct information disclosure and regulation hierarchical content system.Thirdly, to accelerate informationization construction and to improve information disclosure platform and channel. Fourth, to train the information disclosure subjects and strengthen capability building. Fifth, to build up hierarchy and multiple regulation models. Lastly, to improve the institution construction such as communication and cooperation mechanisms, financial assistance, accountability, and non-punitive adverse events reporting system.3.To propose the strategies of the health services information disclosure and regulationFirstly, to establish information disclosure data platform to share the resource. Secondly, to standardize the information, unify statistical analysis, and develop the risk-adjusted method for the information disclosure assessment in order to ensure the accuracy, objectivity and comparability of the data, make full use of the information in health insurance sectors, and reduce the cost of information collection. Lastly, gradual implementation strategies of medical services information disclosure and regulation system construction were proposed.Innovations1.Theoretic innovations:researches on information disclosure at domestic were mainly restricted in the fields of finance, stock market and etc. and systematic research on medical information disclosure and regulation was needed in health field. On the basis of Right to Know Theory, Asymmetric Information theory, Information Communication Theory and Government Regulation Theory, through the theatrical analysis and empirical research,the paper studied systemically and comprehensively the medical services information disclosure from both the government level and hospital level, analyzed the current situation of information disclosure and influencing factors, proposed information disclosure and regulation's objectives, principles, and strategies, to put forward to construct information disclosure and regulation hierarchical content system, which had a theoretical and practical significance to information disclosure and regulation construction.2.Methodological innovations:the domestic references about information disclosure were mainly theoretical paper and quantitative research was scarce. In this study, qualitative and quantitative research methods were combined.